HCPCS Code: v5264
Ear mold/insert, not disposable, any type

v5264 HCPCS Code Description

HCPCS Code

V5264

The Healthcare Common Prodecure Coding System (HCPCS) is a
collection of codes that represent procedures, supplies,
products and services which may be provided to Medicare
beneficiaries and to individuals enrolled in private health
insurance programs. The codes are divided into two
levels, or groups, as described Below:

Level I
Codes and descriptors copyrighted by the American Medical
Association's current procedural terminology, fourth
edition (CPT-4). These are 5 position numeric codes
representing physician and nonphysician services.

**** NOTE: ****
CPT-4 codes including both long and short descriptions
shall be used in accordance with the CMS/AMA agreement.
Any other use violates the AMA copyright.

Level II
Includes codes and descriptors copyrighted by the
American Dental Association's current dental terminology,
(CDT-2018). These are 5 position alpha-numeric codes
comprising the d series. All level II codes and descriptors
are approved and maintained jointly by the alpha-numeric
editorial panel (consisting of CMS, the Health
Insurance Association of America, and the Blue Cross and
Blue Shield Association).
These are 5 position alpha- numeric codes representing
primarily items and nonphysician services that are not
represented in the level I codes.

Short Description

EAR MOLD/INSERT

Short descriptive text of procedure or modifier code
(28 characters or less).
The AMA owns the copyright on the CPT codes and
descriptions; CPT codes and descriptions are not
public property and must always be used in compliance
with copyright law.

Code Description

EAR MOLD/INSERT, NOT DISPOSABLE, ANY TYPE

Contains all text of procedure or modifier long descriptions.
As of 2013, this field contains the consumer friendly
descriptions for the AMA CPT codes. The AMA owns the
copyright on the CPT codes and descriptions; CPT codes
and descriptions are not public property and must always
be used in compliance with copyright law.

v5264 HCPCS Code Pricing Indicators

Multiple Pricing Indicator Code

9

Code used to identify instances where a procedure
could be priced under multiple methodologies.

Multiple Pricing Indicator Code Description

NOT APPLICABLE AS HCPCS NOT PRICED SEPARATELY BY PART B (PRICING INDICATOR IS 00) OR VALUE IS NOT ESTABLISHED (PRICING INDICATOR IS '99')

Multiple Pricing Indicator Code Description

Pricing Indicator Code #1

00

Code used to identify the appropriate methodology for
developing unique pricing amounts under part B. A procedure
may have one to four pricing codes.

Pricing Indicator Code #1 Description

SERVICE NOT SEPARATELY PRICED BY PART B (E.G., SERVICES NOT COVERED, BUNDLED, USED BY PART A ONLY, ETC.)

Description of Pricing Indicator Code #1

v5264 HCPCS Code Dates, Status, Action

Status

ACTUAL

HCPCS Code Status:

ActualActual HCPCS Code

DiscontinuedDiscontinued HCPCS Code

Code Added Date

20020101

The year the HCPCS code was added to the Healthcare common procedure coding system.

Last Update Date

2018

The date that a record was last updated or changed.

Action Effective Date

20020101

Effective date of action to a procedure or modifier code

Termination Date

N/S (NOT SPECIFIED)

Last date for which a procedure or modifier code may be used by Medicare providers.

Action Code

N

A code denoting the change made to a procedure or modifier code within the HCPCS system.

Action Code Description

NO MAINTENANCE FOR THIS CODE

Action Code Description

Anesthesia Base Unit Quantity

0

The base unit represents the level of intensity for
anesthesia procedure services that reflects all
activities except time. These activities include
usual preoperative and post-operative visits, the
administration of fluids and/or blood incident to
anesthesia care, and monitering procedures.
(Note: the payment amount for anesthesia services
is based on a calculation using base unit, time
units, and the conversion factor.)

Processing Note Number

N/S (NOT SPECIFIED)

Number identifying the processing note contained in Appendix A of the HCPCS manual.

Berenson-Eggers Type Of Service Code

O1F

This field is valid beginning with 2003 data.
The Berenson-Eggers Type of Service (BETOS) for the
procedure code based on generally agreed upon clinically
meaningful groupings of procedures and services.

Berenson-Eggers Type Of Service Code Description

HEARING AND SPEECH SERVICES

Berenson-Eggers Type Of Service Code Description

v5264 HCPCS Code Manual Reference Section Numbers

Coverage Issues Manual Reference Section Number #1

N/S (NOT SPECIFIED)

Number identifying the reference section of the coverage issues manual.

Coverage Issues Manual Reference Section Number #2

N/S (NOT SPECIFIED)

Number identifying the reference section of the coverage issues manual.

Coverage Issues Manual Reference Section Number #3

N/S (NOT SPECIFIED)

Number identifying the reference section of the coverage issues manual.

Medicare Carriers Manual Reference Section Number #1

N/S (NOT SPECIFIED)

Number identifying a section of the Medicare carriers manual.

Medicare Carriers Manual Reference Section Number #2

N/S (NOT SPECIFIED)

Number identifying a section of the Medicare carriers manual.

Medicare Carriers Manual Reference Section Number #3

N/S (NOT SPECIFIED)

Number identifying a section of the Medicare carriers manual.

Statute Number

1862A7

Number identifying statute reference for coverage or noncoverage of procedure or service.

v5264 HCPCS Code Lab Certifications

Lab Certification Code #1

N/S (NOT SPECIFIED)

Code used to classify laboratory procedures according
to the specialty certification categories listed by CMS.
Any generally certified laboratory (e.g., 100)
may perform any of the tests in its subgroups (e.g., 110, 120, etc.).

Lab Certification Code #1 Description

N/S (NOT SPECIFIED)

Description of HCPCS Lab Certification Code #1

Lab Certification Code #2

N/S (NOT SPECIFIED)

Code used to classify laboratory procedures according
to the specialty certification categories listed by CMS.
Any generally certified laboratory (e.g., 100)
may perform any of the tests in its subgroups (e.g., 110, 120, etc.).

Lab Certification Code #2 Description

N/S (NOT SPECIFIED)

Description of HCPCS Lab Certification Code #2

Lab Certification Code #3

N/S (NOT SPECIFIED)

Code used to classify laboratory procedures according
to the specialty certification categories listed by CMS.
Any generally certified laboratory (e.g., 100)
may perform any of the tests in its subgroups (e.g., 110, 120, etc.).

Lab Certification Code #3 Description

N/S (NOT SPECIFIED)

Description of HCPCS Lab Certification Code #3

Lab Certification Code #4

N/S (NOT SPECIFIED)

Code used to classify laboratory procedures according
to the specialty certification categories listed by CMS.
Any generally certified laboratory (e.g., 100)
may perform any of the tests in its subgroups (e.g., 110, 120, etc.).

Lab Certification Code #4 Description

N/S (NOT SPECIFIED)

Description of HCPCS Lab Certification Code #4

Lab Certification Code #5

N/S (NOT SPECIFIED)

Code used to classify laboratory procedures according
to the specialty certification categories listed by CMS.
Any generally certified laboratory (e.g., 100)
may perform any of the tests in its subgroups (e.g., 110, 120, etc.).

Lab Certification Code #5 Description

N/S (NOT SPECIFIED)

Description of HCPCS Lab Certification Code #5

Lab Certification Code #6

N/S (NOT SPECIFIED)

Code used to classify laboratory procedures according
to the specialty certification categories listed by CMS.
Any generally certified laboratory (e.g., 100)
may perform any of the tests in its subgroups (e.g., 110, 120, etc.).

Lab Certification Code #6 Description

N/S (NOT SPECIFIED)

Description of HCPCS Lab Certification Code #6

Lab Certification Code #7

N/S (NOT SPECIFIED)

Code used to classify laboratory procedures according
to the specialty certification categories listed by CMS.
Any generally certified laboratory (e.g., 100)
may perform any of the tests in its subgroups (e.g., 110, 120, etc.).

Lab Certification Code #7 Description

N/S (NOT SPECIFIED)

Description of HCPCS Lab Certification Code #7

Lab Certification Code #8

N/S (NOT SPECIFIED)

Code used to classify laboratory procedures according
to the specialty certification categories listed by CMS.
Any generally certified laboratory (e.g., 100)
may perform any of the tests in its subgroups (e.g., 110, 120, etc.).

Lab Certification Code #8 Description

N/S (NOT SPECIFIED)

Description of HCPCS Lab Certification Code #8

v5264 HCPCS Code Cross Reference Codes

Cross Reference Code #1

N/S (NOT SPECIFIED)

An explicit reference crosswalking a deleted code
or a code that is not valid for Medicare to a
valid current code (or range of codes).

Cross Reference Code #1 Description

N/S (NOT SPECIFIED)

Description of HCPCS Cross Reference Code #1

Cross Reference Code #2

N/S (NOT SPECIFIED)

An explicit reference crosswalking a deleted code
or a code that is not valid for Medicare to a
valid current code (or range of codes).

Cross Reference Code #2 Description

N/S (NOT SPECIFIED)

Description of HCPCS Cross Reference Code #2

Cross Reference Code #3

N/S (NOT SPECIFIED)

An explicit reference crosswalking a deleted code
or a code that is not valid for Medicare to a
valid current code (or range of codes).

Cross Reference Code #3 Description

N/S (NOT SPECIFIED)

Description of HCPCS Cross Reference Code #3

Cross Reference Code #4

N/S (NOT SPECIFIED)

An explicit reference crosswalking a deleted code
or a code that is not valid for Medicare to a
valid current code (or range of codes).

Cross Reference Code #4 Description

N/S (NOT SPECIFIED)

Description of HCPCS Cross Reference Code #4

Cross Reference Code #5

N/S (NOT SPECIFIED)

An explicit reference crosswalking a deleted code
or a code that is not valid for Medicare to a
valid current code (or range of codes).

Cross Reference Code #5 Description

N/S (NOT SPECIFIED)

Description of HCPCS Cross Reference Code #5

v5264 HCPCS Code Coverage, Payment Groups, Payment Policy Indicators

Coverage Code

S

A code denoting Medicare coverage status.

Coverage Code Description

NON-COVERED BY MEDICARE STATUTE

Coverage Code Description

ASC Payment Group Code

N/S (NOT SPECIFIED)

The 'YY' indicator represents that this procedure is approved to be
performed in an ambulatory surgical center. You must access the ASC
tables on the mainframe or CMS website to get the dollar amounts.

ASC Payment Group Effective Date

N/S (NOT SPECIFIED)

The date the procedure is assigned to the ASC payment group.

MOG Payment Group Code

N/S (NOT SPECIFIED)

Medicare outpatient groups (MOG) payment group code

MOG Payment Group Code Description

N/S (NOT SPECIFIED)

HCPCS MOG payment group code.

1St digit indicates the body system
2nd digit is sequential numbering within the body system
3rd digit is the level of intensity where:
'1', '2', '3' or '4' represents levels
for a given group type
'0' and '9' represent single level
for a given group type

MOG Payment Policy Indicator

N/S (NOT SPECIFIED)

Indicator identifying whether a HCPCS code is subject
to payment of an ASC facility fee, to a separate
fee under another provision of Medicare, or to no
fee at all.

MOG Payment Policy Indicator Description

N/S (NOT SPECIFIED)

Description of HCPCS MOG Payment Policy Indicator

MOG Effective Date

N/S (NOT SPECIFIED)

The date the procedure is assigned to the Medicare outpatient group (MOG) payment group.

v5264 HCPCS Code Type Of Service Codes

Type Of Service Code #1

K

The carrier assigned CMS type of service which
describes the particular kind(s) of service
represented by the procedure code.

Type Of Service Code #1 Description

HEARING ITEMS AND SERVICES (EFF 04/95)

Description of HCPCS Type Of Service Code #1

Type Of Service Code #2

N/S (NOT SPECIFIED)

The carrier assigned CMS type of service which
describes the particular kind(s) of service
represented by the procedure code.

Type Of Service Code #2 Description

N/S (NOT SPECIFIED)

Description of HCPCS Type Of Service Code #2

Type Of Service Code #3

N/S (NOT SPECIFIED)

The carrier assigned CMS type of service which
describes the particular kind(s) of service
represented by the procedure code.

Type Of Service Code #3 Description

N/S (NOT SPECIFIED)

Description of HCPCS Type Of Service Code #3

Type Of Service Code #4

N/S (NOT SPECIFIED)

The carrier assigned CMS type of service which
describes the particular kind(s) of service
represented by the procedure code.

Type Of Service Code #4 Description

N/S (NOT SPECIFIED)

Description of HCPCS Type Of Service Code #4

Type Of Service Code #5

N/S (NOT SPECIFIED)

The carrier assigned CMS type of service which
describes the particular kind(s) of service
represented by the procedure code.

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